Healthcare Provider Details

I. General information

NPI: 1396476016
Provider Name (Legal Business Name): IVA HOXHA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-5796
  • Fax: 857-364-6538
Mailing address:
  • Phone: 857-364-5796
  • Fax: 857-364-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: